HomeMy WebLinkAboutXR2023-1311 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
" BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
30 ► evewu S-ki Z�l, tiecr PoA)- 9-000 l 0
LEGAL DESCRIPTION
LOT I y I BLOCK TRACT 2 Z L
2. DESCRIPTION OF WORK LGN62)1101 Vdd r l"OCAV O\ phP't'NP4
fvir)l��Mq blu(ML ESTIMATED$ VALUATION Zodo
SWIMMING POOL ❑ SPA fi71 POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
g44684f303
4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
5. CONTRACTOR'S NAME (1
140 1�v",cc ,��
BUSINESS LICENSE
STATE LICENSE
�
is--i iZ Y�
N Class 4�
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
-e �4 Odc,>M-�5 kv4,57y
CITY til<<ti9 lC! I STATE `4 q21 ZIP
PHONE NO.
G� -
3
�E USE PERMITONO. � ZOZ I - 13 1 1 NLY f (7- TIU �j� �
PLAN CHECK NO. FCW7 3 — �' $'
POOL P/C FEE $
DRAINAGE P/C FEE $
forms\Pool spa appl (rev3-04).xls